28 May 2015

Greater Trochanteric Pain Syndrome (GTPS) is a common condition in post-menopausal women that causes pain on the outside of the upper thigh or side of the hip, which can severely debilitate a person with the condition. Australian Physiotherapy Association (APA) member Charlotte Ganderton is conducting the Gluteal La Trobe (GLoBE) trial, which is the first of its kind in the world to assess whether the combination of hormone supplementation and exercise can improve symptoms.

La Trobe University physiotherapist and Associate Dean Academic in the College of Science, Health and Engineering, Charlotte has titled the trial: ‘Does female sex hormone supplementation (FSHS), exercise or a combination of both, improve pain and function in post-menopausal women with greater trochanteric pain syndrome (GTPS)? A Randomised Controlled Trial’.

According to Charlotte, symptoms of the condition can be debilitating: “GTPS patients commonly present with difficulty lying on their side at night, walking up and down stairs, sitting in low chairs and crossing their legs while sitting. They have reduced exercise tolerance because of pain and symptoms can restrict general activity, exercise and ability to participate in work.”

Charlotte said that risk factors like female gender, age, weight and lifestyle changes can lead to GTPS.

“Older women can have tendon and muscle changes due to reduced oestrogen levels and collagen production, which leads to poorer tendon structure. Further risk factors include a reduced angle of hip joint to thighbone in women, increased weight, as well as back pain. A sudden increase in activity, like taking up a new exercise program or increasing walking frequency, can overload an already weakened lateral hip area, leading to GTPS,” she said.

Lateral hip pain can be misdiagnosed as back pain, arthritis, bursitis or tendinitis. This neglects the complexity of the condition and contributes to its poor management. The diagnosis of GTPS represents a more sophisticated approach to understanding lateral hip pain by reflecting the interplay between gluteal tendon, bursa and bony structures in the area.

Most research into lateral hip pain has focused on medical interventions like cortisone injections and operative management.

“Evidence of benefit from conservative and holistic management through exercise has been shown in other tendon pain conditions like the Achilles, shoulder and hamstring, yet there is a dearth of research into similar management of GTPS. This has hindered effective understanding and treatment of the condition.

“The one study that did compare management of GTPS through exercise versus cortisone injections showed that physiotherapy for GTPS offered greater long-term benefits than cortisone injections. This demonstrates that further research into exercise in the treatment of GTPS makes a lot of sense.

“Studies into supplemental oestrogen have found that it is beneficial for increasing skeletal muscle strength, reducing fractures, preserving bone mass and preventing a decline in the collagen content of the skin. Studies have also suggested that tendon cells contain hormone-specific receptors, suggesting the tendon is responsive to oestrogen. Investigating the role of hormone supplementation as a treatment for GTPS is a world first, and is also very important step towards helping patients manage this debilitating condition,” she said.

The Gluteal La Trobe (GLoBE) trial aims to determine if hormone therapy, exercise, or a combination of both can assist in reducing the pain and dysfunction associated with GTPS. Participants will be required to attend four, free 30-40 minute physiotherapy sessions over 12 weeks.

The APA is the peak body representing the interests of Australian physiotherapists and their patients. It is a national organisation with state and territory branches and specialty subgroups. The APA represents more than 17,000 members who conduct more than 21 million consultations each year. To find a physiotherapist in your area, visit www.physiotherapy.asn.au/

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